A fifth San Diego County child has been infected with E. coli bacteria after visiting animal exhibits at the San Diego County Fair, prompting local health officials Tuesday, July 2, to reach out to concerned parents who might be worried their children are next.
Dr. Eric McDonald, medical director of the county’s epidemiology and immunization branch, confirmed in a news conference that a 6-year-old boy who visited the fair on June 22 fell ill on June 26. Like three other children with confirmed or suspected E. coli infections who visited fair animal exhibits, the boy did not suffer severe complications.
“He was treated as an outpatient and is still recovering,” McDonald said.
That was not the case for 2-year-old Jedidiah King Cabezuela, who died on June 24 after a fair visit on June 15. So far, the boy is the only one of the five suspected or confirmed cases to have gotten sick enough to require hospitalization.
Preliminary testing, McDonald said, has confirmed the presence of shiga toxin, a common substance usually found in the presence of shiga-toxin-producing E. coli, a bacteria known to regularly cause outbreaks of food poisoning and one that is commonly present in grass-eating animals such as cattle and goats.
The medical director said the county is currently investigating the suspected case of a 17-year-old boy who tested positive for shiga toxin, but investigators, who only just learned of the case Tuesday afternoon, July 2, have not yet had enough time to do the interviews necessary to determine if the young man visited the fair.
Given that the fair routinely draws more than 1 million visitors, the number of kids and adults potentially exposed to the pathogen is large. After the county announced the first four cases late Friday night, June 28, and held a news conference on the matter early Saturday morning, June 29, McDonald said the requests for pediatric testing roughly doubled.
Dr. John Bradley, an infectious disease specialist with Rady Children’s Hospital in San Diego, said Tuesday that the facility worked with the county to increase its testing and emergency department capacity in order to handle the onslaught of concerned parents.
“I would bet the number of kids being tested with diarrhea for this particular pathogen is at least 10-fold more than it would have been last year and probably even greater,” Bradley said.
Diarrhea is usually the first symptom to show up, and Bradley said parents should feel free to take their kids in for testing if they went to the fair and are concerned. It’s not necessary, he said, to rush in at the first sign.
“It’s not like if your kid has one loose poop you have to go right in,” Bradley said. “You can wait a day, see if it clears up.”
For most patients, it takes between two and four days for symptoms to develop, though, on occasion, the incubation period for STEC bacteria can stretch to 10 days.
E. coli is present in most animals without causing symptoms, but enters humans when they ingest something that is contaminated with the bacteria, usually droppings.
“How quickly you get your symptoms, and how severe they are, is directly proportional to how many bacteria you take in,” Bradley said. “If it’s just a brief touch of an animal, and only a few bacteria, and then you eat a sandwich without washing your hands, that’s probably going to take more days to show up than if a sucker goes down on the poop and then the child picks up the sucker, doesn’t care about the poop, and starts licking again.”
McDonald said the county’s investigation turned up no solid information on what type of potential exposure 2-year-old Cabezuela had, though he did suffer a rare but severe complication that caused severe kidney damage.
For kids who do end up testing positive for STEC bacteria, Bradley had one more critical piece of advice: Make sure that treating doctors don’t prescribe antibiotics. Antibiotics, he said, tend to explode bacteria in ways that just aren’t helpful when they’re filled with a harmful toxin.
“The toxin inside the bacteria can be released all at once if a child is treated with antibiotics, so a child who’s minimally infected, but treated with antibiotics, can get much sicker,” Bradley said.
County health officials said Saturday, and again Tuesday, that they do expect more E. coli cases to appear in coming days, though the likelihood of severe cases lessens with each passing day. Ten days, the longest common incubation period, will have passed as of Monday, July 8. Cases could still pop up after that date, McDonald said, because it often takes several days for patients to seek medical attention and for their infections to be tested and confirmed.
While the number of parents taking their children to Rady’s emergency room appeared to increase significantly over the weekend, that concern did not necessarily translate to doctors offices early this week. Dr. Michelle Dern, a pediatrician with Scripps Coastal Medical Group, said the volume of parents calling with questions on Monday and Tuesday was light.
“We’ve only had a couple of calls, and I’m surprised that there haven’t been more,” Dern said. “So far, it’s not taking up an inordinate amount of time.”
The county also indicated that it assisted the California Department of Food and Agriculture in collecting environmental samples at the fairgrounds, but results from those specimens are not expected to be available until after the fair closes on July 4.
Though 5 percent to 10 percent of those with STEC infections develop life-threatening kidney complications, most recover without needing significant medical attention. Symptoms include: Severe abdominal cramps, watery or blood diarrhea and vomiting.
Hand washing with soap and water is the most effective way to prevent infection.
—Paul Sisson is a reporter for The San Diego Union-Tribune